title: High-dose therapy followed by autologous purged stem cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by the GOELAMS with final results after a median follow-up of 9 years.
abstract: Autologous stem cell transplantation (ASCT) as first-line therapy for follicular lymphoma (FL) remains controversial. The multicenter study randomized 172 patients with untreated FL for either immunochemotherapy or high-dose therapy (HDT) followed by purged ASCT. Conditioning was performed with total body irradiation (TBI) and cyclophosphamide. The 9-year overall survival (OS) was similar in the HDT and conventional chemotherapy groups (76% and 80%, respectively). The 9-year progression-free survival (PFS) was higher in the ASCT than the chemotherapy group (64% vs 39%; P = .004). A PFS plateau was observed in the HDT group after 7 years. On multivariate analysis, OS and PFS were independently affected by the per-formance status score, the number of nodal areas involved, and the treatment group. Secondary malignancies were more frequent in the HDT than in the chemotherapy group (6 secondary myelodysplastic syndrome/acute myeloid leukemia and 6 second solid tumor cancers vs 1 acute myeloid leukemia, P = .01). The occurrence of a PFS plateau suggests that a subgroup of patients might have their FL cured by ASCT. However, the increased rate of secondary malignancies may discourage the use of purged ASCT in combination with TBI as first-line treatment for FL. This trial has been registered with ClinicalTrials.gov under identifier NCT00696735.
authors.affiliation: Department of Hematology, Bretonneau University Hospital, Tours, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gyan
authors.forename: Charles
authors.initials: C
authors.lastname: Foussard
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertrand
authors.forename: Patrick
authors.initials: P
authors.lastname: Michenet
authors.forename: Steven
authors.initials: S
authors.lastname: Le Gouill
authors.forename: Christian
authors.initials: C
authors.lastname: Berthou
authors.forename: Hervé
authors.initials: H
authors.lastname: Maisonneuve
authors.forename: Vincent
authors.initials: V
authors.lastname: Delwail
authors.forename: Rémi
authors.initials: R
authors.lastname: Gressin
authors.forename: Philippe
authors.initials: P
authors.lastname: Quittet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vilque
authors.forename: Bernard
authors.initials: B
authors.lastname: Desablens
authors.forename: Jérôme
authors.initials: J
authors.lastname: Jaubert
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ramée
authors.forename: Nina
authors.initials: N
authors.lastname: Arakelyan
authors.forename: Antoine
authors.initials: A
authors.lastname: Thyss
authors.forename: Cécile
authors.initials: C
authors.lastname: Moluçon-Chabrot
authors.forename: Roselyne
authors.initials: R
authors.lastname: Delépine
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
authors.forename: Philippe
authors.initials: P
authors.lastname: Colombat
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
mesh_terms: D000293:Adolescent; D000328:Adult; D016465:Bone Marrow Purging; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008224:Lymphoma, Follicular / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D016609:Neoplasms, Second Primary / Q000401:mortality*; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists; D003520:Cyclophosphamide